Over the past two years, Alberta Bone & Joint Health Institute and the Bone and Joint Health Strategic Clinical Network have been working closely with surgeons and clinical teams to reduce the need for blood transfusions in elective hip and knee replacement surgery. There is strong evidence linking blood transfusion to poorer clinical and functional outcomes, increased hospital length of stay, and increased rate of in-hospital complications. Furthermore, each precious unit of blood adds about $900 in handling and processing costs, with a typical patient receiving at least two units per transfusion. After reviewing the evidence and blood conservation guidelines, all 12 teams added blood transfusion rates to their site balanced scorecard and initiated local education and review sessions with their surgeons, clinical associates, and respective team members.
Since this project began, there has been a 64% decline in the rate of blood transfusion in elective hip and knee surgeries, from 16.1% in July to September 2012 to 5.8% in January to March 2015. This has saved an estimated $2.8 million in blood transfusion costs for the health system in Alberta over the past two and a half years. There are also signs that this is having a flow on effect as a result of nation-wide efforts on blood conservation. A recent announcement from the Canadian Blood Services attributes the reduction of services to the reduced demand for blood due to developments in blood conservation and technology. While there has been good progress made to date, surgical teams continue to work to improve blood conservation and are now aiming for a target of 5%.